Denmark e-Prescription Services

Denmark is considered the leading country in Europe in terms of eHealth, owing to its long history and significant investment in information and communication technology (ICT). Work began on ePrescribing in the 1990s, and the founding of Medcom in 1994 saw the beginning of a coordinated ePrescribing initiative. A cooperative venture between authorities, organizations and private firms linked to the Danish healthcare sector, Medcom worked with stakeholders to gain consensus and introduce the messages and specifications needed to support projects such as ePrescribing.

The ePrescribing system was a message-broker-based system that used the EDIFACT Med 3 standard for prescriptions based on asynchronous transfer to a secure mailbox. By 2010, ePrescribing rates were reported to be close to 100%. In 2014, it became mandatory for all Danish healthcare providers to use the Shared Medication Record, which effectively phased out the ePrescribing message broker.

Lessons learned include the importance of a single national authority that worked closely with stakeholders to establish infrastructure and define standards, together with the ability to assess compliance with national standards.

Denmark introduced its e-Prescription system nationwide. The Danish Medicines Agency manages the system, and the system is responsible for managing and storing the electronic prescriptions issued by a prescriber. The e-Prescriptions can then be accessed by the patient as well as by prescribers and pharmacies. The e-Prescription records, when accessed by any of the above parties, will provide an overview of all the prescribed medications.

Denmark e-Prescription uses the MedCom communication standard nationwide. MedCom was established in 1994 to develop the communication standards for transferring the medical records and information between health centers nationwide.

The Danish National Health Service Prescription Database was established by Danish Regions and Aarhus University. The purpose of the database is to give Danish researchers the possibility:

• of entering international research collaborations where linking of prescription data with databases abroad is needed
• to be able to document and validate adverse effects by medical record review
• to conduct studies involving contact to general practitioners
• to link data from clinical quality databases with prescription data

Department of Clinical Epidemiology is responsible for running the database.

Danish residents who have redeemed a prescription at a community pharmacy or a hospital-based outpatient pharmacy. Approximately 3.5 million users are registered in the database each year.

Why making electronic Prescriptions?

• Readable
• Reuse of data from general physicians to Pharmacy
• No retyping
• Correct data
• Acknowledge for receiving
• Faster
• No misuse
• Regular dataflow
• Medicine ready when patient show up

E-Prescriptions in Denmark Lessons learnt

• Implementation of CDF and updating at the same time in the GP´s EPR and the Pharmacy systems
• Codes for Dosage and Indication text
• Ordination process included in recommendations
• Test and certification a must
• No problems in EDI communication
• All partners must agree
• Prescriptions readable
• No waiting time
• Even workflow during the day
• Several benefits when electronic
  • Generic substitution
  • Pricing, adjustments
  • Possible access for patients to own data using Internet
  • Control
  • Reuse data
• Developing by bottom up – is not bad
• Savings

Maryam Ghalandari